The Single Accreditation System:

AOA/ACGME Integration

Judith Pauwels, MD

Zach Waterson, DO

Bill Gillanders, MD

AAFP Residency Program Solutions Consultants

Disclosures

• We have no conflicts of interest to

report regarding this presentation.

• Except that we are passionately

committed to Family Medicine.

Disclosures • And We DO represent two

organizations actively collaborating to assist AOA programs with the SAS:

– Association of Family Medicine Residency Directors (AFMRD)

– American College of Osteopathic Family Physicians (ACOFP)

Polling Question #1

• What is your role in your organization?

– Program Director

– Program Faculty

– Program Administrator/Coordinator

– Other

Goals • Describe the Single Accreditation System

process, focusing on the challenges faced by many osteopathic programs.

• Discuss common questions related to Program Accreditation in Family Medicine.

• Describe the Osteopathic Recognition pathway.

• Identify resources to help!

The ultimate goal:

Preserving and enhancing

the primary care workforce

critical to health care system

reform

Polling question #2

• In which general area do you have the

most questions or concerns?

– SAS process and timelines

– Sponsoring Institutional accreditation

– Program accreditation

– Osteopathic recognition

7

Medical School

Medical School

US MLE COMLEX

NRMP Match

Residency

Specialty Boards Specialty Boards

LCM E

NB

ME

NB

OM

E A

OA

AA

MC

A

CG

ME

AB

FM A

OB

FP

MD Students DO Students

SOAP Match

Accredited Sponsoring Institution: Hospital, CHC, OPTI, other

Fully Implemented Unified Pathway: 2020

Osteopathic Recognition

MD DO

Updated 8/6/2015

SAS Process

– Board certification systems are still separate. • Clarification of requirements to sit for AOBFP

Boards under SAS still not announced.

• Must maintain AOA certification for graduating AOA residents to sit for AOBFP Boards.

• For AOA resident to sit for ABFM Boards, must complete BOTH PGY-2 and -3 years in ACGME-accredited program.

SAS Timelines

• All AOA-only residents must be graduated by 2020.

• All current AOA-only programs must achieve Initial Accreditation by June 30, 2020.

• This is now less than 3 years away!

– FM programs MUST have submitted for ACGME accreditation by 1/1/2018 to participate in 2018 AOA match.

SAS Definitions

• “Pre-accreditation” means that the Institution or Program has submitted an initial application for ACGME accreditation (granted immediately upon receipt of the application).

• “Continued pre-accreditation” means that the Institution or Program was reviewed by ACGME but did not receive Initial Accreditation; it can re-apply.

• “Initial accreditation” means the the ACGME has approved the Institution or Program for 2 years.

The Current Numbers • Number of AOA-only FM Programs: 160

– 253 total, of which 93 are dually-accredited

• Number that have Applied to ACGME: 45

– Number in Pre-Accreditation: 22

– Number in Continuing Pre-Accreditation: 13

– Number that have Achieved Initial Accreditation: 10

Time to get Moving!

Data from ACGME Jan 2017

Polling Question #3 • Where is your program in this process:

– SI has been accredited, and program is accredited.

– SI has been accredited; program has applied for accreditation.

– SI has been accredited; program has not yet applied for accreditation.

– SI and program have both applied for accreditation.

– SI has applied for accreditation, but the program has not.

– Neither has applied for accreditation.

Sponsoring Institution (SI)

• Must have accredited SI to

achieve initial program

accreditation.

• Program work can start while SI

is in Pre-Accreditation.

SI Responsibilities

• Sponsoring Institution must demonstrate assumption of ultimate financial and academic responsibility for the programs that it sponsors, and be in substantial compliance with other relevant ACGME Institutional Requirements.

SI Responsibilities

• Oversight of resident/ fellow assignments and of the quality of the learning and working environment, extending to all participating sites.

• Financial support for administrative, educational, and clinical resources, including personnel.

Structure for SI oversight of programs

• Critical elements:

– Written institutional commitment to GME.

– Designated Institutional Official (DIO):

• May be the Program Director in single-program SI.

– An engaged Graduate Medical Education Committee (GMEC).

Common SI Challenges

• No obvious sponsoring institution available.

– Some but not all OPTIs are able to meet the requirements.

• Lack of local institutional resources or support for program accreditation.

PROGRAM requirements

• Common Requirements:

– Apply to ALL programs, regardless of

specialty.

• Specialty-specific Requirements

– Define each specialty.

Common Program Requirements (CPR)

• Affiliation of Sponsoring and Participating Institutions, and “PLAs” (Program Letters of Agreement)

• Specifications about program director and faculty

• General information about resident appointments, educational program, and the competencies

• Expectations of resident scholarly activity

• Evaluation systems

• Resident supervision and duty hours

Family Medicine Program Requirements

• The requirements that define how our specialty trains its residents.

• Specifics about program constructs (program director, faculty, administration, training environment); educational program; resources needed; evaluation systems; etc.

• Some of the CPR are more specifically defined here.

FM Requirements: potential issues

• Program size

• Specifications for the “Family Medicine Practice” clinic

• Program director qualifications and time allocated to program

• Core faculty ratio and time allocated to program; faculty roles; scholarly activity

• Curriculum requirements

Polling Question #4

Which of the Program Requirements is causing you the most concern?

• Program size

• Specifications for the “Family Medicine Practice” clinic

• Program director qualifications and time allocated to program

• Core faculty ratio, time, and roles

• Curriculum requirements

FM Requirements: Program size

• Minimum defined as 4-4-4

• Can smaller programs demonstrate “substantial compliance?”

• Slots must be filled each year under ACGME rules

• Strategies for AOA programs currently smaller than the minimum

FM Requirements: the “Site” and the

“Practice” • Definition of the “Family Medicine Practice”

• Model clinic “Site” for resident continuity practice, specific for Family Medicine (not shared)

• Faculty and residents practice together

• Residents have identifiable panels of patients

• Adequate volumes over the three years, across ages: 1650 direct visits for every resident with specified percentage of younger and older patients

• Other experiences may contribute to the Continuity Practice as long as they are Continuity experiences

FM Requirements: the “Teachers”

• Program director qualifications and time

allocated to program: 0.7 FTE non-clinical

• Core faculty ratio and time allocated to

program: 1:6 faculty/residents at 0.6 FTE

each non-clinical

• Faculty roles; scholarly activity

FM Requirements: the Curriculum

• Problematic areas for many programs:

– Maternity care

– Pediatrics care

– Inpatient internal medicine

• Availability of experiences

FM Requirements:

Other potential issues

• Evaluation system complexities: – Incorporating the Milestones

– Formative evaluations (direct observations)

– Summative evaluations

– CCC (Clinical Competency Committee)

• Faculty and program confidential evals

FM Requirements:

Other potential issues

• Supervision requirements

• ”Wellbeing” (duty hours, fatigue mgmt)

• Administrative complexities:

– PEC (Program Evaluation Committee)

– ADS (Accreditation Data System) reports

Program Pre-accreditation

• Programs must start reporting all required ACGME annual information: – ADS annual update

– Resident survey

– Faculty survey

– Milestone assessment and reporting

• Can simultaneously start application for Osteopathic Recognition

Program Accreditation

• Initial accreditation will be for

two years.

• If not approved the first time,

the program can continue to

revise its plans and then

reapply, until June 2020.

Program Support and Finances

Financial Considerations

• Federal and state GME revenue streams:

– CMS rules only relate to accreditation; either AOA or ACGME accreditation is required to claim residents.

– Program must maintain AOA accreditation until Initial Accreditation by ACGME is received.

Financial Considerations • Sponsoring Institution costs:

– DIO, GMEC

– Increased administrative requirements

• Program costs:

– Additional director and faculty time

– Family Medicine practice site requirements

– Educational requirements

– Systems/administrative requirements

Polling Question #5

• What costs are you most concerned

about?

– Sponsoring Institution costs

– Additional director and faculty time

– Family Medicine practice site requirements

– Educational requirements

– Systems/administrative requirements

Osteopathic Recognition • Osteopathic Recognition is conferred upon any ACGME-

accredited graduate medical education program providing requisite training in the Osteopathic Principles and Practice (OPP).

• Programs may designate the entire program as osteopathic-focused or designate a portion of the program as an osteopathic-focused track.

• Osteopathic-focused programs must include integration of Osteopathic Principles and Practice into the six ACGME core competency areas.

Osteopathic Recognition

• Basic OR Requirements: Program Personnel – Must have an assigned leader - PD/Co-PD/ or OR

Track Director

– Must have one other OR Track faculty (minimum of two including PD)

• Practice in variety of settings (ie Hospital, FMP, NH, etc)

• Participate in Rounds, Journal club, Conferences, etc. that integrate OPP/OMT

Osteopathic Recognition

• Basic OR Requirements: Scholarly Activity

– Faculty: Must produce at least 2 scholarly pieces

annually, averaged over a five year period.

– Residents: Must produce at least 1 piece of scholarly

activity prior to graduation.

• Basic OR Requirements: OR Milestones

– 7 Sub-competencies

Osteopathic Recognition

• The Application Process:

– Located and completed in ACGME WebADs

– Can apply at the same time as Program is applying

– Majority of the OR application is completed in

preparing your program application – you do not have

to duplicate the work!

• Does require uploading a few additional documents.

Osteopathic Recognition

• Why Pursue it??? – Moral/Ethical decision to ensure OPP/OMT training

and distinctiveness maintained

– Very strong pool of DO applicants that want FM & OPP/OMT Training – will seek out programs with OR

– Not easy, but most programs should not have difficulty achieving OR

• Will you recruit MD’s???

Networking for Strength – Fundamental belief in the need for

primary care, and specifically family medicine, for our patients and communities.

– Core value that all of us working together are stronger than working in isolation.

– NO program has found all of this “easy.”

– But ALL programs have found this rewarding!

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Poll Question:

Enter your email address to be included in any follow-up communication from the presenter(s).

45

Please…

Complete the

session evaluation.

Thank you.

46

Resources

– Association of Family Medicine Residency Directors (AFMRD) – Become a member and have access to the members only toolbox and discussion list.

– Residency Program Solutions – When a program consultation is called for, AAFP’s RPS has experienced consultants to meet your needs.

– American Osteopathic Association – Multiple resources on website

– American College of Osteopathic Family Physicians – Offers programs free assistance

Resources

ACGME: – https://www.acgme.org/What-We-

Do/Accreditation/Single-GME-

Accreditation-System

– https://www.acgme.org/Meetings-and-

Events/Webinars (see link under SAS - FM

on this page)